Epidemiology, Risk Factors, and Outcomes of Opportunistic Infections after Kidney Allograft Transplantation in the Era of Modern Immunosuppression: A Monocentric Cohort Study

Epidemiology of opportunistic infections (OI) after kidney allograft transplantation in the modern era of immunosuppression and the use of OI prevention strategies are poorly described. We retrospectively analyzed a single-center cohort on kidney allograft adult recipients transplanted between January 2008 and December 2013. The control group included all kidney recipients transplanted in the same period, but with no OI. We analyzed 538 kidney transplantations (538 patients). The proportion of OI was 15% (80 and 72 patients). OI occurred 12.8 (6.0–31.2) months after transplantation. Viruses were the leading cause (n = 54, (10%)), followed by fungal (n = 15 (3%)), parasitic (n = 6 (1%)), and bacterial (n = 5 (0.9%)) infections. Independent risk factors for OI were extended criteria donor (2.53 (1.48–4.31), p = 0.0007) and BK viremia (6.38 (3.62–11.23), p < 0.0001). High blood lymphocyte count at the time of transplantation was an independent protective factor (0.60 (0.38–0.94), p = 0.026). OI was an independent risk factor for allograft loss (2.53 (1.29–4.95), p = 0.007) but not for patient survival. Post-kidney transplantation OIs were mostly viral and occurred beyond one year after transplantation. Pre-transplantation lymphopenia and extended criteria donor are independent risk factors for OI, unlike induction therapy, hence the need to adjust immunosuppressive regimens to such transplant candidates.

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Hepatotoxicity induced by antituberculosis drugs among patients coinfected with HIV and tuberculosis

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2012000400009 ◽

2012 ◽

Vol 28 (4) ◽

pp. 698-708 ◽

Cited By ~ 16

Author(s):

Maria de Fátima Silva de Lima ◽

Heloísa Ramos Lacerda de Melo

Keyword(s):

Risk Factors ◽

Protective Factor ◽

Hepatitis Virus ◽

Control Group ◽

Case Group ◽

High Concentration ◽

Antituberculosis Drugs ◽

Cd4 Cell Count ◽

Independent Risk Factors ◽

Cd4 Cell

Hepatotoxicity due to antituberculosis drugs limits treatment in patients coinfected with HIV and tuberculosis. We conducted a case-control study to identify risk factors for hepatotoxicity among patients coinfected with tuberculosis and HIV in two hospitals in Recife, Pernambuco State, Brazil. The sample consisted of 57 patients (36.5% of the total) who developed hepatotoxicity and a control group of 99 patients (63.5% of the total), who did not present this effect. Hepatotoxicity consisted of jaundice or a high concentration of AST/ALT or total bilirubinemia. Multivariate logistic regression showed that a T CD4+ count of < 200cells/mm³ increased the risk of hepatotoxicity by a factor of 1.233 (p < 0.001) and that coinfection with hepatitis B or C virus increased this risk by a factor of 18.187 (p = 0.029). Discharge occurred among 66.1% of the case group (p = 0.026). The absence of hepatotoxicity was a protective factor against death (OR = 0.42; 95%CI: 0.20-0.91). Coinfection with the B and C hepatitis virus and a T CD4+ cell count below 200cells/mm³ were independent risk factors for hepatotoxicity in these patients

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Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection

Journal of Clinical Medicine ◽

10.3390/jcm10050928 ◽

2021 ◽

Vol 10 (5) ◽

pp. 928

Author(s):

Takuya Okugawa ◽

Tadayuki Oshima ◽

Keisuke Nakai ◽

Hirotsugu Eda ◽

Akio Tamura ◽

...

Keyword(s):

Risk Factors ◽

Medical Records ◽

Colorectal Polyp ◽

Control Group ◽

Single Center ◽

Antithrombotic Agents ◽

Delayed Bleeding ◽

Factors Associated ◽

Independent Risk Factors ◽

Continuous Use

Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6–2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding (DPPB). Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection. Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of DPPB. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of historical control patients and patients after instruction were compared. Results: A total of 3318 polyps in 1002 patients were evaluated. The control group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. DPPB occurred in 1.1% of polyps in control, and 0.4% in after-instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for DPPB even after instruction. Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.

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Multifocal Papillary Thyroid Carcinoma，Hashimoto's Thyroiditis and Lymph Node Metastasis：A Retrospective Cohort Study

10.21203/rs.3.rs-194311/v1 ◽

2021 ◽

Author(s):

Denghui Wang ◽

Jiang Zhu ◽

Chang Deng ◽

Zhixin Yang ◽

Daixing Hu ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastases ◽

Protective Factor ◽

Roc Curves ◽

Multivariate Logistic Regression ◽

Lateral Lymph Node ◽

Node Metastases ◽

Independent Risk Factors ◽

Central Lymph

Abstract Objective: Few studies have evaluated the influence of HT and Multifocality on central lymph node metastases(CLNM) and lateral lymph node metastases(LLNM) of PTC. The present study focused on risk factors for lymph node metastasis in PTC according to the presence of HT or multifocality. Materials and methods:1413 patients were identified.The relationship between HT or multifocality and lymph nodemetastasis was analyzed by univariate and multivariate logistic regression, ROC curves were constructed to show the predictive effect of each variable on the target outcome.Results: The PTCs with HT were more likely to be multifocal.(40.0% versus 17.5%,P ＜0.001). Compared to MPTC without HT, MPTC with HT showed a lower number of metastatic CLNs and LLNs (P < 0.05). HT was identifified as an independent protective factor for CLNM in all PTC patients (OR, 0.480; 95% CI, 0.359-0.643; P< .001) and in MPTC patients (OR, 0.094; 95% CI, 0.044-0.204; P < 0.001), the multicocality was independent risk factors for CLNM(OR, 2.316; 95% CI, 1.667-3.217; P< 0.001) and LLNM(OR, 2.004; 95% CI, 1.469-2.733; P< 0.001).The variables concluded HT or MPTC were screened to predict CLNM in all patients, CLNM in patients with MPTC and LLNM in all patients (AUCs: 0.731, 0.843 and 0.696, respectively, P < 0.0001). The two type of diseases existed concurrently may result in the decrease of CLNM and LLNM, AUCs of ROC to predict CLNM and LLNM are 0.696 and 0.63(P<0.0001). Conclusions: Our study identified multifocality as an independent risk factor predicting CLNM and LLNM in PTC patients. HT was proven to be a protective factor that reduced the CLNM risk in all patients and in patients with MPTC. The existence of both type of diseases can result in the reduction of CLNM and LLNM.

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Risk Factors for Failure of Direct Current Cardioversion in Patients with Type 2 Diabetes Mellitus and Atrial Fibrillation

BioMed Research International ◽

10.1155/2018/5936180 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Handrean Soran ◽

Moulinath Banerjee ◽

Jamal B. Mohamad ◽

Safwaan Adam ◽

Jan Hoong Ho ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Left Atrial ◽

Control Group ◽

Left Atrial Size ◽

Direct Current Cardioversion ◽

Atrial Size ◽

Independent Risk Factors ◽

Lv Ejection Fraction

Introduction. Type 2 diabetes mellitus (T2DM) is a well-recognised risk factor for cardiovascular disease and the prevalence of atrial fibrillation (AF) is higher among patients with T2DM. Direct current cardioversion (DCCV) is an important management option in persistent AF. We sought to determine independent risk factors for immediate and short-term outcomes of DCCV for treatment of AF in patients with T2DM. Methods. Retrospective outcome analysis of DCCV for persistent AF in 102 T2DM patients compared with 102 controls. Results. DCCV was successful in 68 (66.6%) people with T2DM compared to 86 (84.3%) in the control group (P=0.003). After initial successful cardioversion, only 38 (37.2%) T2DM patients remained in sinus rhythm compared to 63 (61.8%) in the control group (P=0.007) at a median follow-up of 74.5 days (IQR 69.4–77.4). Multiple logistic regression analysis showed that the presence of T2DM (P=0.014), digoxin use (P=0.01), statin use (P=0.005), left-atrial size (P=0.01), and LV ejection fraction (P=0.008) were independent risk factors for immediate DCCV failure. T2DM (P=0.034) was an independent risk factor for AF relapse. Among patients with T2DM, previous DCCV (P=0.033), digoxin use (P=0.035), left-atrial size (P=0.01), LV ejection fraction (P=0.036), and HbA1c (P=0.011) predicted immediate failure of DCCV whilst digoxin use (P=0.026) was an independent risk factor for relapse of AF. Conclusion. T2DM, higher HbA1c, digoxin treatment, and structural and functional cardiac abnormalities are independent risk factors for immediate DCCV failure and AF relapse.

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Risk factors for methicillin-resistantStaphylococcus aureusbacteraemia differ depending on the control group chosen

Epidemiology and Infection ◽

10.1017/s0950268813000174 ◽

2013 ◽

Vol 141 (11) ◽

pp. 2376-2383 ◽

Cited By ~ 4

Author(s):

M. POGORZELSKA-MAZIARZ ◽

E. Y. FURUYA ◽

E. L. LARSON

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Organ Transplant ◽

Severity Of Illness ◽

Venous Catheter ◽

Case Control ◽

Control Group ◽

Major Organ ◽

Independent Risk Factors ◽

Nested Case Control

SUMMARYMethicillin-resistantStaphylococcus aureus(MRSA) bacteraemia cause significant morbidity and mortality in hospitalized patients. Using a nested case-control design, 204 MRSA bacteraemia cases were compared to 301 unmatched methicillin-susceptibleStaphylococcus aureus(MSSA) bacteraemia controls and were matched 1:2 with non-infected controls. The independent risk factors for MRSA bacteraemia compared to MSSA bacteraemia were older age (P = 0·048), major organ transplant during current hospital stay (P = 0·016) and quinolone use (P = 0·016). Cases were more likely than non-infected controls to have renal failure (P = 0·003), cirrhosis (P = 0·013), and a central venous catheter (P = 0·003) after controlling for other risk factors. This large case-control study made it possible to assess risk factors for MRSA bacteraemia using two sets of controls and showed that risk factors differed greatly depending on the control group chosen. These results confirm the need for careful selection of appropriate control groups and the need to carefully adjust for underlying severity of illness.

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Periodontal disease and effects of antipsychotic medications in patients newly diagnosed with schizophrenia: a population-based retrospective cohort

Epidemiology and Psychiatric Sciences ◽

10.1017/s204579601900043x ◽

2019 ◽

Vol 29 ◽

Author(s):

Kai-Fang Hu ◽

Pei-Shan Ho ◽

Yu-Hsiang Chou ◽

Jui-Hsiu Tsai ◽

Chung-Hung Richard Lin ◽

...

Keyword(s):

Risk Factors ◽

Periodontal Disease ◽

First Generation ◽

Protective Factor ◽

Population Based ◽

Newly Diagnosed ◽

Sugary Drinks ◽

Increased Risk ◽

History Of ◽

Independent Risk Factors

Abstract Aim Compared with the general population, individuals with schizophrenia have a higher risk of periodontal disease, which can potentially reduce their life expectancy. However, evidence for the early development of periodontal disease in schizophrenia is scant. The current study investigated risk factors for periodontal disease in patients newly diagnosed with schizophrenia. Methods We identified a population-based cohort of patients in Taiwan with newly diagnosed schizophrenia who developed periodontal disease within 1 year of their schizophrenia diagnosis. Treatment with antipsychotics and other medications was categorised according to medication type and duration, and the association between medication use and the treated periodontal disease was assessed through logistic regression. Results Among 3610 patients with newly diagnosed schizophrenia, 2373 (65.7%) had an incidence of treated periodontal disease during the 1-year follow-up. Female sex (adjusted odds ratios [OR] 1.40; 95% confidence interval [CI] 1.20–1.63); young age (adjusted OR 0.99; 95% CI 0.98–0.99); a 2-year history of periodontal disease (adjusted OR 2.45; 95% CI 1.84–3.26); high income level (adjusted OR 2.24; 95% CI 1.64–3.06) and exposure to first-generation (adjusted OR 1.89; 95% CI 1.54–2.32) and secondary-generation (adjusted OR 1.33; 95% CI 1.11–1.58) antipsychotics, anticholinergics (adjusted OR 1.24; 95% CI 1.03–1.50) and antihypertensives (adjusted OR 1.91; 95% CI 1.64–2.23) were independent risk factors for periodontal disease. Hyposalivation – an adverse effect of first-generation antipsychotics (FGAs) (adjusted OR 2.00; 95% CI 1.63–2.45), anticholinergics (adjusted OR 1.27; 95% CI 1.05–1.53) and antihypertensives (adjusted OR 1.90; 95% CI 1.63–2.22) – was associated with increased risk of periodontal disease. Therefore, hypersalivation due to FGA use (adjusted OR 0.72; 95% CI 0.59–0.88) was considered a protective factor. Conclusions The current study highlights that early prevention of periodontal disease in individuals with schizophrenia is crucial. Along with paying more attention to the development of periodontal disease, assessing oral health regularly, helping with oral hygiene, and lowering consumption of sugary drinks and tobacco, emphasis should also be given by physicians to reduce the prescription of antipsychotics to the extent possible under efficacious pharmacotherapy for schizophrenia.

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Relationship between Random Blood Glucose, Fasting Blood Glucose, and Gensini Score in Patients with Acute Myocardial Infarction

BioMed Research International ◽

10.1155/2019/9707513 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9

Author(s):

Yuhan Qin ◽

Gaoliang Yan ◽

Yong Qiao ◽

Changle Ma ◽

Juchuan Liu ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Blood Glucose ◽

Coronary Angiography ◽

Fasting Blood Glucose ◽

Control Group ◽

Multiple Logistic Regression ◽

Gensini Score ◽

Stress Hyperglycemia ◽

Independent Risk Factors

Objective. To examine the relationship between admission random blood glucose (RBG), fasting blood glucose (FBG), and Gensini score in patients with acute myocardial infarction (AMI) to clarify the effects of RBG and FBG on the severity of coronary artery disease. Method. A total of 958 consecutive AMI patients who underwent emergency coronary angiography at the Cardiology Department of Zhongda Hospital (affiliated with Southeast University) were enrolled in this study from January 1, 2016, to December 31, 2018. The Gensini score of each patient was calculated according to the results of coronary angiography. The RBG, FBG, baseline data, hematological indexes, echocardiography parameters, coronary angiography data, and the use of intra-aortic balloon pump (IABP) were recorded. Patients with an RBG level >11.1 mmol/L were classified into the stress hyperglycemia group, and those with an FBG level >7.0 mmol/L were classified into the elevated FBG group. The Gensini scores in the stress hyperglycemia and elevated FBG groups were compared to those in the control group, and correlations between the RBG and FBG levels and the Gensini scores of AMI patients were evaluated. Independent risk factors for the Gensini score were analyzed by multiple linear and multiple logistic regression analyses. Results. The Gensini scores of the stress hyperglycemia group and the elevated FBG group were higher than those of the control group. RBG and FBG were positively correlated with the Gensini score, and there were significant differences between RBG and FBG in different Gensini score groups. After adjusting for confounding factors, multiple linear regression analysis showed that sex, diabetes, estimated glomerular filtration rate (eGFR), and FBG were independent risk factors for the Gensini score. Multiple logistic regression analysis showed that age and FBG were independent risk factors in group 2 compared to group 1, eGFR and FBG were independent risk factors in group 3, and eGFR and FBG were independent risk factors in group 4. Diabetes and RBG were not independent risk factors for the Gensini score. Conclusion. The Gensini scores of patients in the stress hyperglycemia group and the elevated FBG group were significantly higher than those in the control group. RBG and FBG were positively correlated with the Gensini score in AMI patients, and FBG was an independent risk factor for the Gensini score in AMI patients.

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A clinical prediction model for estimating the risk of developing uveitis in patients with juvenile idiopathic arthritis

Rheumatology ◽

10.1093/rheumatology/keaa733 ◽

2020 ◽

Author(s):

Joeri W van Straalen ◽

Gabriella Giancane ◽

Yasmine Amazrhar ◽

Nikolay Tzaribachev ◽

Calin Lazar ◽

...

Keyword(s):

Risk Factors ◽

Prediction Model ◽

Protective Factor ◽

Prediction Models ◽

Characteristic Curve ◽

Multivariable Analysis ◽

Information Criterion ◽

Logistic Regression Models ◽

Adjusted Risk ◽

Independent Risk Factors

Abstract Objective To build a prediction model for uveitis in children with JIA for use in current clinical practice. Methods Data from the international observational Pharmachild registry were used. Adjusted risk factors as well as predictors for JIA-associated uveitis (JIA-U) were determined using multivariable logistic regression models. The prediction model was selected based on the Akaike information criterion. Bootstrap resampling was used to adjust the final prediction model for optimism. Results JIA-U occurred in 1102 of 5529 JIA patients (19.9%). The majority of patients that developed JIA-U were female (74.1%), ANA positive (66.0%) and had oligoarthritis (59.9%). JIA-U was rarely seen in patients with systemic arthritis (0.5%) and RF positive polyarthritis (0.2%). Independent risk factors for JIA-U were ANA positivity [odds ratio (OR): 1.88 (95% CI: 1.54, 2.30)] and HLA-B27 positivity [OR: 1.48 (95% CI: 1.12, 1.95)] while older age at JIA onset was an independent protective factor [OR: 0.84 (9%% CI: 0.81, 0.87)]. On multivariable analysis, the combination of age at JIA onset [OR: 0.84 (95% CI: 0.82, 0.86)], JIA category and ANA positivity [OR: 2.02 (95% CI: 1.73, 2.36)] had the highest discriminative power among the prediction models considered (optimism-adjusted area under the receiver operating characteristic curve = 0.75). Conclusion We developed an easy to read model for individual patients with JIA to inform patients/parents on the probability of developing uveitis.

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Severe neurological outcomes after very early bilateral nephrectomies in patients with autosomal recessive polycystic kidney disease (ARPKD)

Scientific Reports ◽

10.1038/s41598-020-71956-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Kathrin Burgmaier ◽

◽

Gema Ariceta ◽

Martin Bald ◽

Anja Katrin Buescher ◽

...

Keyword(s):

Risk Factors ◽

Kidney Disease ◽

Polycystic Kidney Disease ◽

Autosomal Recessive ◽

Neurological Complications ◽

Control Group ◽

Polycystic Kidney ◽

Neurological Outcomes ◽

Additional Control ◽

Independent Risk Factors

Abstract To test the association between bilateral nephrectomies in patients with autosomal recessive polycystic kidney disease (ARPKD) and long-term clinical outcome and to identify risk factors for severe outcomes, a dataset comprising 504 patients from the international registry study ARegPKD was analyzed for characteristics and complications of patients with very early (≤ 3 months; VEBNE) and early (4–15 months; EBNE) bilateral nephrectomies. Patients with very early dialysis (VED, onset ≤ 3 months) without bilateral nephrectomies and patients with total kidney volumes (TKV) comparable to VEBNE infants served as additional control groups. We identified 19 children with VEBNE, 9 with EBNE, 12 with VED and 11 in the TKV control group. VEBNE patients suffered more frequently from severe neurological complications in comparison to all control patients. Very early bilateral nephrectomies and documentation of severe hypotensive episodes were independent risk factors for severe neurological complications. Bilateral nephrectomies within the first 3 months of life are associated with a risk of severe neurological complications later in life. Our data support a very cautious indication of very early bilateral nephrectomies in ARPKD, especially in patients with residual kidney function, and emphasize the importance of avoiding severe hypotensive episodes in this at-risk cohort.

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Serum MMP-9 and SAA in the Diagnosis of Severe Pneumonia Caused by Radiotherapy of Esophageal Cancer

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/6032546 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Yu Zhou ◽

Li Liu ◽

Wenjun Gu

Keyword(s):

Risk Factors ◽

Esophageal Cancer ◽

Lung Function ◽

White Blood Cells ◽

Severe Pneumonia ◽

Diagnostic Value ◽

Control Group ◽

Radiation Group ◽

Severe Group ◽

Independent Risk Factors

Objective. To explore the relationship and diagnostic value of serum MMP-9 and SAA in severe pneumonia (sCAP) caused by radiotherapy of esophageal cancer. Methods. A total of 144 esophageal cancer patients who underwent radiotherapy in our hospital from April 2016 to February 2018 were collected. Among them, 58 patients without radiation pneumonitis (RP) were in the control group, 49 patients with grade 1∼2 RP were in the radiation group, and 37 patients with sCAP were in the severe group. The levels of serum MMP-9 and SAA in every group of patients were detected. The ROC curve was used to determine the diagnostic value of serum MMP-9 and SAA in the diagnosis of RP and sCAP. The correlation between serum MMP-9 and SAA and the patient’s lung function indexes was analyzed, and the logistic single-factor and multivariate analyses were performed to analyze the factors of sCAP in esophageal cancer radiotherapy. Results. PaO2, FVC, and FEV1 decreased in RP and sCAP, and PaCO2, white blood cells, serum MMP-9, and SAA levels increased ( P < 0.05 ); serum MMP-9 and SAA were negatively correlated with lung function ( P < 0.05 ); the AUC of serum MMP-9 and SAA in RP was 0.833 and 0.823, respectively, and the AUC of the two combined diagnosis of RP was 0.919. The AUC of serum MMP-9 and SAA in sCAP was 0.809 and 0.797, respectively, and the AUC of both combined diagnosis of sCAP was 0.873; logistics multivariate analysis found that serum MMP-9, serum SAA, double lung V5, and V20 were independent risk factors for sCAP caused by radiotherapy for esophageal cancer ( P < 0.05 ). Conclusion. Serum MMP-9 and SAA increase in RP and sCAP and are negatively correlated with lung function in patients with pneumonia. They are independent risk factors for severe pneumonia caused by radiotherapy of esophageal cancer and have good diagnostic value.

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